The Chaplain as a Member of the Multidisciplinary Team- An Ethical Risk?

1
The Chaplain as a Member of the Multidisciplinary
Team-An Ethical Risk?

• Janet Young, Mary-Lou Martin, Rosemary Garside,
• Sandra Berzaitis-Smith, Kathy Carlin,
• Gwen Davidson

2
Background

• Chaplains have been an integral part of the
  clinical team
• Debate about whether chaplains should be part of
  the clinical team in mental health
• Potentially conflict between the needs of the
  client, the team spiritual care provider

3
Practical Question

• Should there be standard guidelines related to
  this issue?

4
Ethical Questions

• How does the chaplain meet clients spiritual
  needs?
• How can clients benefit from spiritual care how
  can any harm be avoided?
• Should chaplains protect the confidentiality of
  clients personal information?
• Should chaplains be expected to disclose clients
  information to the clinical team vice versa?

5
Ethical Questions

• Should chaplains document have access to the
  clients casebook?
• What happens to inter-professional collaboration
  when one party does not share information?
• What is the duty of the chaplain who has a client
  disclose to them a risk of harm to self or
  others?
• What is the responsibility of the employer in
  this situation?

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Spirituality

• The search for the sacred. A conscious striving
  to move beyond isolation and self-absorption to a
  deeper awareness of interconnectedness with the
  self, other human beings and the transcendent.
  (Catholic Health Association of Canada 2000, p.
  102)

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Religion

• The expression of spirituality through
  traditions, rites and practices usually within
  the context of an organized faith. (The Catholic
  Health Association of Canada, 2000, p. 100).

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Spiritual Religious Care

• The activity of chaplains, community clergy,
  faith leaders and laity in helping persons to
  discover and deepen life and give expression to
  their spirituality and/or religion.
• (The Catholic Health Association of Canada,
  2000, p. 102)

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Reasons To Include Spirituality Religion In
Mental Health Services

• Reflection of consumer self-understanding
• Facilitation of recovery
• Enhancement of cultural sensitivity of services
• Positively related to psychosocial well-being
• (Fallot, 2001)

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Barriers To Spirituality

• History of mental health treatments
• Professional stereotypes
• Confusion fear about the meaning of
  spirituality
• (Longo Peterson, 2002)

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Helping Relationship

• Trust
• Respect
• Honesty
• Confidentiality
• Privacy
• Quality care

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Confidentiality

• Confidentiality is a quality of human
  communication that protects a persons right to
  privacy by fostering trust between the care
  provider and the person receiving care.
  Confidentiality excludes unauthorized persons
  from gaining access to information concerning the
  person receiving care, and requires that people
  who have such information refrain from
  communicating it to others
• (The Catholic Health Association of Canada,
  2000, p. 94)

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Protecting Confidentiality

• What measure are in place?
• Do clients have the right to expect assume that
  chaplains will not disclose personal information?
• Are their limits to the bounds of confidentiality
• Should the chaplain only disclose information as
  authorized by the client

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Protection of Privacy

• Every person has the right to privacy. This
  includes privacy of personal information,
  confidentiality, and freedom from the unwanted
  intrusions of others in their immediate
  situation. This privacy must be carefully
  respected by care providers in their professional
  and informal conversations.Exception to the
  right of privacy must be clearly justified by
  those claiming them. Exceptions may be justified
  in situation where the right to privacy is
  limited by the dematnd of the common good.
• (The Catholic Health Association of Canada,
  2000, p. 33)

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Free Informed Consent

• Capacity
• Possible risks
• Benefits
• Best interests

16
Perspective Of The Chaplain
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Role of Chaplain?

• Wall-Mart greeter
• Advocate
• Touchstone in crisis
• Parish Priest
• Confessor
• Officiator at celebrations
• Communicator of bad news

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Clients Describe Chaplains

• Hey Chaplain!
• Sister
• Pastor, Reverend or Minister
• Priest
• Hospital Mother
• Friend
• Charlie

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Community Faith Leaders Expectations

• Authority figure
• Keeper of confidences
• Faith expert
• Evangelist
• Always compassionate will no time restraints
• Someone to show your best side to
• Representative of what has wounded/ rejected in
  the past
• Connection with the Divine

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Chaplains Perspective

• Trained professional
• Masters Degree in Theology/Pastoral Counselling
• Specialist in Clinical Pastoral Education with
  CAPPE/ACPEP
• Code of Ethics
• Faith Group Endorsement for Institutional
  Ministry
• Multifaith Training and Evaluation

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Chaplains Perspective

• Oversee Spiritual Care at CMHS
• Place Mentor Students
• Support Volunteers Community Clergy
• Provide Crisis Support for Staff
• Provide Education on Spirituality
• Subject to PHIPA Hospital Policies The
  Ontario Human Rights Code regarding Creed
• Work Within the Recovery Model
• Member of the Ethics Committee

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How Can A Chaplain Minister To People Of Other
Faiths?

• Some chaplains may, in fact, agree that
  religiosity is merely one expression of
  spirituality yet claim that, because all patients
  are spiritual beings, they should routinely be
  visited by a chaplaincy service because chaplains
  have "special expertise" in all matters
  spiritual.
• Leowy Leowy
  (2007, p. 53)

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• Being a person of faith exposes one to what is
  held in common with other faiths e.g. moral
  values, choices, worship, prayer, limitations,
  aha moments, community, etc.

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Values That Promote Care Sensitive To Culture

• Equality All persons are equally, fully human,
  equally deserving of positive regard.
• Mutuality Human beings are relational beings who
  are fully alive in reciprocal exchange
• Integrity All persons are responsible
  individuals capable of thinking their own
  thoughts, feeling feelings, choosing options.
• 
  (Augsburger, 1986)

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Additional Values That Promote Care Sensitive To
Faith

• Humility Always being open to ones own
  fallibility
• A Sense of Wonder Taking delight in the
  unexpected and new as well as recognizing the
  beauty and grace revealed in everyday life.

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Unique Perspective

• This strategy does not call for the healthcare
  provider to become an expert in cultural
  minutaeIdeally, being appropriately cognizant
  and responsive to cultural issues should not be
  thought of as reaching a competency so much as
  engaging in an ongoing process of honing and
  applying skills for self-awareness and for
  respectful recognition of the unique perspective
  each patient brings to the clinical encounter.
• (Hunt,
  2001, p.1882)

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Can A Chaplain Provide Counselling?
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CAPPE Code of Ethics

• supports disclosing information for necessary
  treatment, ..for the safety of any person or as
  required by law. Otherwise disclosure requires
  client permission.
• Members are subject to the law in their
  jurisdiction.
• The code also deals with knowing the limits of
  ones expertise and working with and making
  referrals to other professionals whenever it is
  in the best interest of those being served.
• (CAPPE, 2007)

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Psychotherapy Defined

• The practice of psychotherapy is the assessment
  and treatment of cognitive, emotional or
  behavioural disturbances by psychotherapeutic
  means, delivered through a therapeutic
  relationship based primarily on verbal or
  non-verbal communication.
• (Pychotherapy Act,
  2007, p. 118)

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Should A Chaplain Keep A Clients Confidentiality?

• ..we suspect that most patients assume that
  chaplains in the healthcare setting operate on
  much the same principles as do clergy -- if I
  confide in my clergyperson, I can expect strict
  confidentiality (unless, of course, what I have
  confided places another at risk). I assume that a
  chaplain is also bound by that strict
  confidentiality unless I am explicitly told
  otherwise.
• 
  (Loewy Loewy, 2007, p.53)

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CAPPE Code of Ethics

• No clear guidance
• It requires that we enter chart notes
• there is judgment required as to what is
  necessary to communicate for the benefit of the
  client.
• (CAPPE,
  2007, p. 118)

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Perspective Of The Consumer
33
My Story My Journey

• My life
• My mental health
• My religion
• My experience
• My profession occupational therapist
• My spirituality
• My recovery

34
Spirituality Defined

• Sensitivity to religious values practice of
  personal devotion and prayer. Relating to ones
  spirit and higher consciousness as distinct from
  ones earthbound body and nature

35
Perspective Of The Recreational Therapist
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Therapeutic Recreation

• Therapeutic recreation is a process that utilizes
  treatment, education recreation participation
  to enable persons with physical, cognitive,
  emotional /or social limitations to acquire /or
  maintain the skills, knowledge behaviours that
  will allow them to enjoy their leisure optimally,
  function independently with the least amount of
  assistance participate as fully as possible in
  society.

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Recreational Therapists Intervention

• What is meaningful to the person
• Goals are based on the persons expressed needs
• Standard assessment tools specific to spirituality

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Therapeutic Recreation (TR) Issues

• Therapeutic recreation may not be supported as
  treatment
• Spirituality is incorporated into TR practice
• TR has commonalities with other professions
• Complimentary service between TR
  chaplaincy/spiritual care
• Joint interventions

39
Spirituality

• Common experience connecting us
• Search for meaning purpose
• Connectedness hope

40
Contact Info

• Janet Young
• jyoung_at_stjosham.on.ca
• Mary-Lou Martin
• martinm_at_stjosham.on.ca